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Wisconsin rates for HCPCS C9091

Sirolimus, Protein-Bound,1mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.14 / $65.14 / $65.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.14 / $65.14 / $81.42
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.90 / $507.90 / $507.90